Observation Checklist

The Observation Checklist Form is to be used exclusively by the Smart Meal program manager/organization for the purpose of quality assurance. The form is to be used to determine the level of restaurant implementation of the Smart Meal program, in accordance with the Agreement / Membership form.

The checklist should be completed at least once/year for each restaurant. If a restaurant has many locations, a sampling of restaurants can be used to represent the overall restaurant evaluation.

When visiting the restaurant, please look for evidence of the Smart Meal Seal program and record it on the form below. Also record other observations relative to healthy choices at the restaurant. Please do not inform the server or other restaurant staff that you are making these observations.

Observer Name:
Email Address:
Phone:
Restaurant Name:
Address:
City/State:
ZIP/Postal Code:

Observation Date:

The "Smart Meal" sticker is displayed in the window.
If yes, please note its location in the comment column.

Yes

Comment:

The Smart Meal Seal sticker is displayed on menu boards or other places
inside the restaurant. If yes, please note its location in the comment column.

Yes

Comment:

The "Smart Meal Seal" sticker is displayed beside items on the menu.

Yes

Comment:

The server or other restaurant staff talk about healthy options.

Yes

Comment:

Other observations: